Heads in the cloud

Though the U.S. has already spent more than half the $22.5 billion earmarked for computerizing medical records, there has been achingly slow progress in creating an accessible, interoperable system that works for patients. It didn't take long walking around the trade show floor at last week's Healthcare Information and Management Systems Society's annual conference to understand some of the roadblocks.

I come at this issue first and foremost as a medical consumer. I can access my bank records, pay my bills, look at yesterday's performance of my retirement assets and review my daughter's grades at college with a few clicks of a computer mouse—or do it all on my smartphone while at lunch. How many Americans can say the same thing about their medical records?

More than two decades into the Internet revolution, the answer to that question remains precious few. Primary-care physician practices are beginning to offer their patients computer portals where can they can access their most recent records and even send their doctors e-mails. But if their experience is like mine, those records have little or no information from the last physician who had responsibility for their care—unless they verbally reported it.

And that gets to the heart of why interoperability was the watchword at HIMSS and why it is key to making this huge investment by U.S. taxpayers pay off. The typical American will hold a dozen jobs by the time they reach age 50. Though the nation has become less mobile in the wake of the Great Recession, more than 10% of the population still moves every year.

Since healthcare delivery is inherently local and most Americans still get their health insurance through their place of work, this occupational and geographic mobility translates into multiple changes in insurers and providers over the course of a lifetime. Without complete and seamless interoperability, the grand promise of electronic medical records—that it will empower patients, lead to better and better-coordinated care and lower costs—will never be achieved.

So why is it taking so long? The fragmentation among suppliers is one reason. The field is dominated by a handful of relatively large players with proprietary systems aimed at specialized audiences. Some cater to large hospital systems; others to physician practices. Literally hundreds of software providers surround these major players by filling niches in the market, which in turn spawned another set of firms that specialize in building pipes to connect the cacophony of electronic data.

Interoperability represents a direct threat to their business models—and raises the specter that at the end of the process, just one or two firms will dominate the field, rendering most of the smaller players extinct.

The major providers—the large hospital systems and large physician practices—have their own reasons for dragging their feet when it comes to interoperability. Allowing access to all medical records through a cloud-based health information exchange makes it easier for patients or physicians to seamlessly transfer their records and care to another provider or payer. There aren't many businesses that look kindly on information systems that facilitate their customers walking across the street for a lower-priced or higher-quality producer.

The government could cut through this Gordian knot by setting a performance standard for interoperability. The payment system would be simple: If your system plays well with others, you get paid. Otherwise, you don't. Instead, it set benchmarks and postponed achievement dates.

Last fall, some leaders of key congressional committees began raising questions about the failure to achieve interoperability with the billions spent by the government.

Don't be surprised if later this year, healthcare industry leaders and the head of the Office of the National Coordinator for Health Information Technology are called to testify on why things aren't farther along.

Merrill Goozner, Editor